Skin cancer can be tricky, so make sure to show your doctor

Uticaod

Writer

Posted May. 31, 2010 at 12:01 AM
Updated May 31, 2010 at 3:10 PM

Posted May. 31, 2010 at 12:01 AM
Updated May 31, 2010 at 3:10 PM

By Julie Deardorff

McClatchy News Service

As a sun lover with a fair complexion and a history of blistering sunburns, I’ve spent much of the last decade waiting for skin cancer. So when I noticed that a fleshy pink nodule on the side of my head seemed to be growing exponentially, I headed to the dermatologist for official confirmation.

In less than five seconds, Dr. Roopal Kundu dismissed the unsightly growth. But after lightly tracing my face with her fingers, she zeroed in on a tiny red spot above my lip that I’ve had for, oh, about a year. “This could be precancerous,” she said, lightly rubbing the tiny rough spot.

It’s a common mistake: I worried more about an ugly (but harmless) lesion than a potentially problematic one. And although I thought I knew the signs of melanoma, the most lethal type of skin cancer, I couldn’t spot precancer — actinic or solar keratoses — or the two forms of non-melanoma skin cancer, called basal cell and squamous cell carcinomas, if they landed on my face.

Actinic (solar) keratosis and non-melanoma cancers do not lead to melanoma because they begin in different types of cells. But it’s important to know the signs of all skin cancers because they all can cause health problems, including local tissue destruction. The earlier skin cancer is caught, the easier it is to treat.

Skin cancer misconceptions

The earlier skin cancer is caught, the easier it is to treat. But common misconceptions deter many people from getting mysterious bumps or lesions checked out. Here are six common excuses patients have for missing skin cancer, according to dermatologists.

I thought a raised lesion was more dangerous than a flat one. “Most early melanomas are flat,” said Orlando dermatologist William Grisaitis. “The important thing is that that flat spot is changing and getting bigger.” Many raised gray-brown spots, meanwhile, are actually seborrheic keratoses or “barnacles,” which are benign and never become skin cancers.

I was waiting for it to go away. Some people mistake a basal cell carcinoma for a pimple or razor bump. “The basal cell may last more than one month at exactly the same location,” said Dr. Murad Alam, an associate professor of dermatology, otolaryngology and surgery at Northwestern University. If a lesion hasn’t healed in six to eight weeks, have it checked by an expert.

It’s in a spot where the sun doesn’t shine. Melanoma can occur anywhere on the body, including areas that aren’t exposed to the sun. In women, it often appears on the legs, neck and face. Men often get melanoma on the chest or back. “Look at your scalp, groin, soles and buttocks, said Dr. Lee Laris, a Phoenix dermatologist. “If it has skin on it, it can get skin cancer, even your lips, inside your mouth or on your eye.”

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My moles didn’t change. An evolving mole can indicate melanoma. But “the most common type of skin cancer is basal cell carcinoma, which isn’t a mole at all, but a pink pearly bump most often found on the face, ears and upper back, said dermatologist Raphael Darvish of Los Angeles. “Squamous cell carcinomas, which are less common than basal cells, can show up as crusty lesions on the skin, mostly on the face.”

It didn’t hurt. “When it comes up quickly and hurts, it could be a fast-growing squamous cell skin cancer. But most skin cancers have no symptoms; they feel like normal skin and are not painful,” Grisaitis said.

It was tiny. “People tend to worry about spots that are large. In fact, melanomas can be a few millimeters wide,” said Alam, chief of cutaneous surgery at Northwestern. “Size does not equate with dangerousness.” Non-melanoma skin cancers can also be subtle, Alam said. “These most commonly occur on the face and backs of arms and may be slightly raised red areas, or crusty areas. They may not be the largest or ugliest-looking spots on the face.”